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Long-term enteral nutrition in infants and young children with chronic renal failure
S E Ledermann1, V Shaw, R S Trompeter
1Renal Unit, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK.
Insights
Enteral feeding (EF) improves growth in children with chronic and end-stage renal failure (CRF/ESRF). Early intervention before age two promotes significant catch-up growth, preventing weight loss and growth retardation in pediatric renal patients.
Area of Science:
- Pediatric Nephrology
- Nutritional Science
- Growth and Development
Background:
- Inadequate nutritional intake is a significant issue for children with chronic and end-stage renal failure (CRF/ESRF).
- Poor weight gain and growth retardation are common complications in this pediatric population.
- Enteral feeding (EF) is a potential intervention to address these nutritional deficits.
Purpose of the Study:
- To evaluate the impact of a structured enteral feeding (EF) program on growth, nutritional intake, and oral feeding outcomes in children with CRF/ESRF.
- To assess the effectiveness of EF in preventing or reversing growth retardation and weight loss.
- To determine if early initiation of EF influences catch-up growth potential.
Main Methods:
- A cohort of 35 children with CRF/ESRF (mean age 1.6 years) participated in an EF program for a mean of 30 months.
- Growth parameters, including weight and height standard deviation scores (SDSs), were tracked before and during EF.
- Nutritional intake as a percentage of estimated average requirements was monitored throughout the study.
Main Results:
- Significant improvements in weight and height SDSs were observed in both the 0-2 and 2-5 year age groups during the EF program (P<0.0003).
- Energy intake as a percentage of estimated average requirements did not change significantly, but absolute intake increased with age.
- Twenty-one children underwent renal transplants, with 86% achieving normal oral intake post-transplant.
Conclusions:
- Long-term enteral feeding (EF) effectively prevents or reverses weight loss and growth retardation in children with CRF/ESRF.
- Early initiation of EF, particularly before age two, is associated with significant catch-up growth.
- EF is a crucial supportive therapy for pediatric patients with renal failure, improving nutritional status and growth outcomes.
Abstract:
An inadequate nutritional intake is common in infants and young children with chronic and end-stage renal failure (CRF/ESRF), causing poor weight gain and growth retardation. In a programme of enteral feeding (EF), growth, nutritional intake and outcome for oral feeding were evaluated in 35 children with CRF/ESRF, mean (range) age 1.6 (0-4.9) years at start of EF for 30 (12-60) months. Twenty-nine had a glomerular filtration rate of 12.1 (6-26) ml/min per 1.73 m(2) and 6 were on peritoneal dialysis. Mean (SD) weight standard deviation scores (SDSs) in the 0 to 2-year age group (n=26) were -3.3 (1.0) 6 months before EF, -3.1 (1.3) at the start, -1.7 (1. 4) at 1 year, (P=0.0003) and -1.4 (1.8) at 2 years, (P=0.0008). Height SDSs were -2.9 (0.7), -2.9 (1.2), -2.2 (1.2) (P=0.008) and -2. 1 (1.3) (P=0.004). Weight SDSs in the 2 to 5-year age group (n=9) were -2.3 (1.2), -2.0 (1.1), -1.1 (1.3) (P=0.002) and -0.9 (1.0) (P=0.04). Height SDSs were -2.8 (0.6), -2.3 (0.7), -2.0 (0.7) and -2. 0 (0.8). There was no change in energy intake as a percentage of the estimated average requirement, nor was this exceeded. Percentage energy from the EF in the 0 to 2 year age group remained unchanged despite an absolute increase in energy intake with age. Twenty-one have had renal transplants, of whom 86% eat and drink normally. Long-term EF prevents or reverses weight loss and growth retardation in children with CRF/ESRF, with the achievement of significant catch-up growth if started before age 2 years.